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'-- ar .�.^l!'�� <br /> it � <br /> m '� L//�;��J/ 7 7 <br /> Date 4[� pupi¢WorMs Permil a � / ✓� / <br /> Application For �� eie� oep�.. <br /> N <br /> PUIBLIC WORK� �ERMIT PdbOCWorkSFeC <br /> Total Fee g <br /> O <br /> 0 Less 4001.Fae Pai� $ <br /> Print or Type Only � o n oa���«o�� 5 ZG" <br /> a <br /> W O O <br /> C+l C'� Cd <br /> al M <br /> t <br /> N <br /> �^.-'�'�--�A�z.��--r �cs�,�-��'4r- Cdc=,c� ��� �,�r X �`1c �, J� ba��t� <br /> Ow�er AtaiiinaAC�r�S p� �,�'�— Cit��� ]in ��_ � hone C���i,� <br /> \ a a � la J� L�t <br /> . <br /> J:R_�-� ( �.�.� �o c� �r�-�,� � �4 a�rz�- 7 � <br /> Applicant rn:,�oo�nddress City —Tip-- Phone <br /> Describe Proposed Work IEt��SZ��1y�-�_llOtjC�p��,,., ��_���,�--�� <br /> �r- �-���� �-1�����t�v <br /> Project Add�ess(il knownl � \]_��C�c�u_Z__��_ 1-.� � <br /> Attach fou�(A) copies ot plans for proposed work � Draw, tn scal�� ann ne�e Iha 1�owing as appficahie: � <br /> • Property Lines • Cenlerline nf street � <br /> • Outline and dimensions of all existing and • IndicatM Norih <br /> proposed s�ructures on the lol • Show any r.ronosed grading r,hanges <br /> . • Existing and proposed utilities • Show measwemenls � <br /> DO NOT WRITE BELOW THiS LINE <br /> PERMIT CONDITIONS O <br /> 7.All calls tor inspection shall be made 24 hrs.in advance-phone 258-8870. � <br /> 2.All work shall be performed in acccrdance with this permit and current City of Everelt Design and Construction <br /> Standards and Specifications. <br /> 3.Lall Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> �"• f�s �' d f�Lhed dr�;n yr �" ��mor����•�-r. <br /> � Ti�{'�� �con �/ af �.- d,'n��� o ��%f`7 �'�r-rc � <br /> �n9!'�e� � <br /> (o, �(/o ti� /�.t,�cfa,o ts �✓h/zh �ir� �t�� �.� ��/� �/� <br /> 7i GonE/�1c�o/ �"S �"CS�s�6[a {orPro�eC��n ar�d �n.�:nftf�h,la� fhG �'h{a,jnf% li <br /> o�fh.c SGw�f r►�alY, ci,i-,1�sJ f�,,3 con sE��w,f,iv�c�• <br /> (�, t?esEvr+G "a��l�!ty -lo ci� s�zndt�rd �3v3 �b c,-�d o�j��°%�� �ol� GB <br /> PC✓ ��t�0�+ �4UZ ACKNOWLEDGGMENT OF CONDITIOIJS <br /> The under�iqned o�vner/applicant hereby agrees to hold and save harm• <br /> , ---�—� less the�Gity of Everett Irom any and all claims for dama9es. cosls. <br /> � �r� � � azpenses. o� causes of aclion tha� may arise 6ecause of installation <br /> �7Cp`_ 8//�/9 � and mainlenance o! the improvement or other righhol-way use hereto <br /> appl�ed for and lurfher agrees to remove same upon notice Irom the <br /> Approved`forConstruc '� �T- Ci1 , <br /> � y and to replac2 public property damoged thereby. <br /> I <br /> /-i7 -q'� � •` <br /> FINAL INSPECTION Date i �e�.Ilb �G-� <br /> Approved as Constructed Signature of Applicant �Date <br /> I PUBLIC WORKS DEPARTMENT WaRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> i` 3200CetlarStreet 190 DAYS OF DATE PERMIT IS ISSUEp AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGEnTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 GANCELLED BY"ThiE CIT'f UPON ANY STOPPAGE OF WORK ON THIS <br /> PRO,IECT OVER 90 DAYS DURATION. <br /> � I <br /> i <br /> I <br /> i <br />